During this council, the teaching on transubstantiation— a doctrine of the Roman Catholic Church which describes the method by which the bread and wine offered in the sacrament of the Eucharist becomes the actual blood and body of Christ— was defined.

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Lateran IV stands as the high-water mark of the medieval papacy. Its political and ecclesiastical decisions endured down to the Council of Trent while modern historiography has deemed it the most significant papal assembly of the Later Middle Ages.[2] The Fourth Lateran Council was the largest and most representative of the medieval councils to that date.[3]

In summoning the bishops to a general council, Innocent III emphasized that reforms must be made in the Church and that a new crusade to the Holy Land must be launched. He also reminded them that it was not appropriate that their retinue include birds and hunting dogs.[4]

The agenda laid out in Vineam domini Sabaoth included reform of the Church, the stamping out of heresy, establishing peace and liberty, and calling for a new crusade.[4] During this council, the doctrine of transubstantiation— a Church doctrine which describes the method by which the bread and blood offered in the sacrament of the Eucharist becomes the actual blood and body of Christ— was infallibly defined.[5] The scholarly consensus is that the constitutions were drafted by Innocent III himself.[3]

In secular matters, the Council confirmed the elevation of Frederick II as Holy Roman Emperor.[3]

Canon 3: Procedure and penalties against heretics and their protectors. If those suspected of heresy should neglect to prove themselves innocent, they are excommunicated. If they continue in the excommunication for twelve months they are to be condemned as heretics. Princes are to be admonished to swear that they will banish all whom the Church points out as heretics. This canon mandates that those pointed by the Church as heretics shall be expelled by the secular authorities or they will be excommunicated if failing to do so.

Canon 4: Exhortation to the Greeks to reunite with the Roman Church.[8]

Canon 13: A good deal of Innocent III's time had been spent judging complaints of bishops against the religious orders. This canon forbade the establishment of new religious orders. Those who wished to found a new house were to choose an existing approved rule. It is this canon that led Saint Dominic to adopt the Rule of St. Augustine.[8]

Canon 18: Clerics may neither pronounce nor execute a sentence of death. Nor may they act as judges in extreme criminal cases, or take part in matters connected with judicial tests and ordeals. This last prohibition, since it removed the one thing that gave the ordeal its value, was the beginning of the end of Trial by ordeal.[4]

Canon 19: Household goods must not be stored in churches unless there be an urgent necessity. Churches, church vessels, and the like must be kept clean.

Canon 21, the famous "Omnis utriusque sexus", which commands every Christian who has reached the years of discretion to confess all his, or her, sins at least once a year to his, or her, own[9] priest. This canon did no more than confirm earlier legislation and custom, although it is sometimes incorrectly quoted as commanding the use of sacramental confession for the first time. In actuality the confession came into existence over a long period of time.[10] However, this was the first time that it took the shape of the Christian confessional as we know it today.[10]

Canon 22: Before prescribing for the sick, physicians shall be bound under pain of exclusion from the Church, to exhort their patients to call in a priest, and thus provide for their spiritual welfare.

Canons 50–52: There had been kings of France and Castile who had repudiated their wives and "remarried" with serious public consequences. Marriage, impediments of relationship, publication of banns were addressed in Canon 50.[11]

^At that time this referred at least chiefly to the parish priest. However, its actual meaning is what is now called a "priest with faculties", specifically the authority to hear the respective penitent's confession. This authority is now more broadly distributed among priests.